Early Life Holds Clues to Adult Heart Health

Action Points

Note that this analysis of three cohort studies demonstrated that risk factors present in childhood are associated with cardiovascular disease in adulthood.

Be aware that there was a substantial number of participants who were lost to follow-up; these individuals may differ from those that could be evaluated up to two decades after the initial assessment.

Family socioeconomic status, body mass index, and either personal or parental smoking during childhood predicted the likelihood of achieving ideal cardiovascular health as an adult, researchers found.

Better socioeconomic status and lower BMI were significantly associated with having ideal cardiovascular health 2 to 3 decades later in three cohort studies conducted in Finland, Australia, and the U.S. (P<0.01 for both variables), according to Tomi Laitinen, BM, of the University of Turku in Finland, and colleagues.

In addition, personal smoking was a predictor of ideal cardiovascular health in the Australian cohort and parental smoking was a predictor in the Finnish cohort (P≤0.001 for both), the researchers reported online in the International Journal of Cardiology.

A study published 2 years later showed that 2% of Americans or fewer achieved ideal status on all seven factors from 1988 to 2010, and that 59% of all deaths, 64% of cardiovascular deaths, and 63% of ischemic heart disease deaths could have been prevented during that time if people had attained ideal cardiovascular health.

A previous study by Laitinen and colleagues further showed that the number of ideal factors present in childhood was associated with adult risks of hypertension, metabolic syndrome, high LDL cholesterol, and high-risk carotid intima-media thickness.

In the current study, the researchers set out to identify factors in children and teens that predicted the presence of ideal cardiovascular health in adults using data from three studies -- the Cardiovascular Risk in Young Finns Study from Finland, the Childhood Determinants of Adult Health Study from Australia, and the Princeton Follow-up Study from the U.S.

The analysis included a total of 4,409 participants ages 3 to 19 at baseline (average ages 10.8 to 12.5). Follow-up was conducted when participants were ages 30 to 48.

In adulthood, the average number of ideal health characteristics achieved by the participants was 3.5 in the Finnish study, 3.9 in the Australian study, and 3.8 in the U.S. study.

Higher family socioeconomic status defined by parental education or income and lower BMI were associated with ideal cardiovascular health in adulthood in all three cohorts after multivariate adjustment. Additional predictors included systolic blood pressure, LDL cholesterol, and parental smoking in the Finnish study and personal smoking in the Australian study.

Laitinen and colleagues further explored the relationships with family socioeconomic status and parental smoking, and found that socioeconomic status was directly associated with ideal smoking status and BMI in all three cohorts.

They calculated that children who came from families with low socioeconomic status or whose parents smoked might have a 15% to 25% elevated risk of cardiovascular disease as adults compared with other kids.

Even after adjustment for each participant's own socioeconomic status as an adult, the correlation between family socioeconomic status during childhood and ideal cardiovascular health in adulthood remained significant in the Finnish and U.S. cohorts.

"These data ... support the recent AHA Scientific Statement, which encourages to implement community-wide interventions that are socially and culturally appropriate to reduce disparities and inequities in the cardiovascular health of socioeconomically disadvantaged subgroups," the authors wrote.

They acknowledged some limitations of their analysis, including the assessment of smoke exposure using self-report and not biochemical testing and the possibility that individuals who continued in the studies differed from those who were lost to follow-up.

The Cardiovascular Risk in Young Finns Study has been financially supported by the Academy of Finland, the Social Insurance Institution of Finland, Kuopio, Tampere, and Turku University Hospital Medical Funds, Juho Vainio Foundation, Paavo Nurmi Foundation, Finnish Foundation of Cardiovascular Research and Finnish Cultural Foundation, Sigrid Juselius Foundation, Orion-Farmos Research Foundation, Tampere Tuberculosis Foundation, and Emil Aaltonen Foundation. The Childhood Determinants of Adult Health Study was funded by grants from the Australian National Health and Medical Research Council, the Australian National Heart Foundation, the Tasmanian Community Fund, and Veolia Environmental Services. It was sponsored by Sanitarium Health Food Company, ASICS Oceania, and Target Australia. The Princeton Follow-up Study was supported by the American Heart Association, the NIH, and the National Heart, Lung, and Blood Institute.

Laitinen did not report any conflicts of interest. The other authors reported support from a National Health and Medical Research Council Career Development Fellowship and a National Health and Medical Research Council Early Career Fellowship.

Reviewed by F. Perry Wilson, MD, MSCE Instructor of Medicine, Perelman School of Medicine at the University of Pennsylvania and Dorothy Caputo, MA, BSN, RN, Nurse Planner

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